Until about two years ago I viewed elective surgical reshaping of the neck differently than I do now. Then, I thought of the neck lift operation as something that should or should not accompany a face lift operation. Now, I view the neck quite differently. In many ways, I often find myself assessing whether a face lift should accompany the neck lift operation.

When examining the postoperative patient, my eyes begin and finish with the contour of the neck. The neck ultimately serves as the elegant pedestal for the face above. Without such elegance, even the perfect jawline and facial features seem incongruous. In fact, while suboptimal, the opposite also holds truth. That is, sometimes the beautifully contoured neck makes more youthful an unaddressed jawline or mild jowls, as in the photo below.

I have learned there can be no cookbook approach to neck lift surgery. As many specialized facial surgeons would attest, this seems true for most aspects of facial plastic surgery. As do the nose, midface, and lower eyelids, the neck affords a set of challenges unique to each patient. These challenges require a deciphering eye, a preoperative plan, likely intraoperative evaluation and adaptation, and action with careful attention to detail.

For example, any neck can have a variable amount of subplatysmal fat (fat deep to the muscle of the neck), submental fat (fat beneath the skin of the neck), cervical skin laxity (looseness versus elasticity of skin), position of cartilaginous structures (which often afford the scaffolding for soft tissue redraping), associated projection of mandible and chin, thickness and integrity of platysma muscle (thin sheet of muscle of the neck), size and prominence of submandibular glands, lateral triangle fat (fat adjacent the angle of the mandible), associated jowls, length, and associated hairline. Each of these elements (and more) is addressed specifically, and in relation to one another with a customized neck lift. Therefore, neck lift surgery is really an art form that requires what I like to call “surgical sensibility.”

Many patients who consult with me, enter consultation believing they want a miniature face lift operation. These patients are often correct, when it comes to the face. However, when we speak about the neck, and the modest improvement any “miniature” operation can yield there, we often find ourselves focusing the next 20 minutes on many of the details involving their true reason for consultation. Most patients want significant improvement along the contours of the neck. Subsequent surgical planning is often affected more by focused conversation regarding the neck, than the face.

Just as each patient finds themselves captivated by their own neck, I find myself similarly engaged. Manipulations of the neck can exist across a broad spectrum, from subtle to significant. Over recent years I have refined my operative technique from being less extensive with dissection, to being much more extensive. I have learned to appreciate the true aesthetic importance of a beautiful neck, and all that is involved with creating one.  

As the accomplished neck surgeon Dr. Joel Feldman once wrote:

“Where, you ask, does Beauty dwell?

I’ll share what I’ve discovered –

That though the face may draw a crowd,

It’s the neck that lures a lover.”

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